Stanford APBI Trial
Clinical Trial
Overview
Intraoperative Radiotherapy (IORT) is one of three approaches used for accelerated, partial breast irradiation at Stanford.
Accelerated, partial breast irradiation (APBI) is a potentially important new way to incorporate radiotherapy in the treatment of women with breast cancer.
Currently, women with breast cancer who undergo a lumpectomy typically have 6 1/2 weeks of radiation to the entire affected breast after surgery. Accelerated, partial breast irradiation (APBI) changes this approach in two ways. It shortens the treatment time from 6 1/2 weeks to between 1 to 5 days, and reduces the treatment area from the entire breast to the area of the breast immediately around the lumpectomy site. This is the part of the breast where most cancers are likely to recur.
In many ways APBI is to current whole breast radiotherapy what a lumpectomy is to a mastectomy. The goal is to use a less invasive more focused treatment without compromising survival.
APBI has been used in limited trials in several hundred patients over the last 10 years. These trials show that in properly selected breast cancer patients APBI worked just as well as whole breast radiotherapy. In the initial studies, investigators relied on the placement of many catheters in the breast tissue (interstial brachytherapy). Newer techniques will hopefully provide the same good results but will deliver the radiation in faster and/or more convenient ways. This could increase interest in APBI and allow additional clinical trials that test the safety and effectiveness of the newer approaches. These newer approaches could increase quality of life for many women with breast cancer.
Investigators at Stanford University Medical Center are currently offering an IRB approved clinical trial that uses three new approaches for APBI. These three approaches are:
Intraoperative Radiotherapy (IORT) - 1 day
Intracavitary Brachytherapy (MammoSite) - 5 days
3-D Conformal/External Beam Radiotherapy - 5 days
The Stanford trial is led by Dr. Frederick Dirbas, Assistant Professor of Surgery, and by Dr. Donald Goffinet, Professor of Radiation Oncology. For further information about the trial please contact Janelle Maxwell or Triona Dolphin at (650) 498-7740.
A Study of Clofarabine and Cytarabine for Older Patients With Relapsed or Refractory Acute Myelogenous Leukemia (AML)(CLASSIC I)
Clofarabine (injection) is approved by the Food and Drug Administration (FDA) for the treatment of pediatric patients 1 to 21 years old with relapsed acute or refractory lymphoblastic leukemia (ALL) who have had at least 2 prior treatment regimens.
There is no recommended standard treatment for relapsed or refractory acute myelogenous leukemia in older patients. Cytarabine is the most commonly used drug to treat these patients. This study will determine if there is benefit by combining clofarabine with cytarabine. Patients will be randomized to receive up to 3 cycles of treatment with either placebo in combination with cytarabine or clofarabine in combination with cytarabine. Randomization was stratified by remission status following the first induction regimen (no remission [i.e., CR1 = refractory] or remission <6 months vs CR1 = remission ≥6 months). CR1 is defined as remission after first pre-study induction regimen. The safety and tolerability of clofarabine in combination with cytarabine and cytarabine alone will be monitored throughout the study.
Stanford is currently not accepting patients for this trial.
Intervention(s):
- drug: clofarabine (IV formulation)
- drug: placebo
- drug: cytarabine
Eligibility
Inclusion Criteria:
- Have a diagnosis of Acute Myelogenous Leukemia (AML) according to World Health
Organization (WHO) classification
- Relapsed after receiving up to 2 prior induction regimens (i.e. first or second
relapse)or are refractory to not more than one prior combination chemotherapy
induction regimen
- Be ≥ 55 years of age
- Have an Eastern Cooperative Oncology Group (ECOG) score of 0-2
- Be able to comply with study procedures and follow-up examinations
- Be nonfertile or agree to use birth control during the study through the end of
treatment visit and for at least 90 days after the last dose of study drug
- Have adequate liver and renal function as indicated by certain laboratory values
Exclusion Criteria:
- Received previous treatment with clofarabine
- Received bolus, intermediate or high-dose cytarabine as induction therapy unless
certain remission criteria are met
- Have received a hematopoietic stem cell transplant (HSCT) within the previous 3 months
- Have moderate or severe graft versus host disease (GVHD), whether acute or chronic
- Are receiving any other chemotherapy or investigational therapy. Patients must have
been off prior AML therapy for at least 2-6 weeks prior to entering study.
- Have a psychiatric disorder that would interfere with consent, study participation, or
follow-up
- Have an active, uncontrolled infection
- Have any other severe concurrent disease, or have a history of serious organ
dysfunction or disease involving the heart, kidney, liver, or other organ system
- Have been diagnosed with another malignancy, unless disease-free for at least 5 years;
patients with treated nonmelanoma skin cancer, in situ carcinoma, or cervical
intraepithelial neoplasia, regardless of the disease-free duration, are eligible for
this study if definitive treatment for the condition has been completed; patients with
organ-confined prostate cancer with no evidence of recurrent or progressive disease
are eligible if hormonal therapy has been initiated or the malignancy has been
surgically removed.
- Have clinical evidence suggestive of central nervous system (CNS) involvement with
leukemia unless lumbar puncture confirms absence of leukemic blasts in the
cerebrospinal fluid(CSF)
- Known HIV positivity
- Are pregnant or lactating
Ages Eligible for Study
55 Years - N/A
Genders Eligible for Study
All
Not currently accepting new patients for this trial
Contact Information
Stanford University
School of Medicine
300 Pasteur Drive
Stanford,
CA
94305
Richa Rajwanshi
6507364031
Not Recruiting
What's New
Stanford’s APBI trial has now been expanded to include women with ductal carcinoma in situ (DCIS). Please call 650-498-7740 for more information.